Patients who undergo heart valve replacement need to take blood thinning drugs for life. Dr Annie Elliott, 64, a former GP and acupuncturist from near Market Harborough, Leicestershire, had a new type of valve that avoids this. She tells CAROL DAVIS her story.

THE PATIENT

After my daughter Anneka’s wedding in October 2016, I started to feel a strange flutter in my chest — sometimes lasting around five minutes.

I thought it was because I’d been rushing round and doing the flowers for the wedding, but it kept coming back several times a day, so a week later I went to my GP. He suspected it could be pericarditis, inflammation in the lining of the heart — I’d had a bout in 1994, which doctors couldn’t explain.

Two weeks later, I had hospital tests — 24-hour heart rate monitoring and an echocardiogram, where they examine your heart through the chest using ultrasound — and then a CT scan three months later.

My results showed that my heart rate was fast and my aortic valve, which opens and closes to send blood from the heart into the rest of the body, was enlarged and leaky, so my heart was having to work extra hard.

Dr Annie Elliott, 64, a former GP and acupuncturist from near Market Harborough, Leicestershire, had a new type of valve that avoids this. She tells CAROL DAVIS her story

Also, my aorta — the main artery that carries blood from the heart — was enlarged and because it had become so stretched, the artery wall was becoming thinner and was at risk of rupturing, which could be fatal.

In the meantime, it was pulling on the heart valve and damaging it further.

They didn’t know what had caused the artery to enlarge —though it could have been linked to the pericarditis I’d had before.

My symptoms weren’t getting any worse, but I was still very concerned. So I was referred to an aortic specialist on the NHS, who said I would need open-heart surgery to repair the damaged aorta and replace the faulty valve.

I was then referred to Professor Giovanni Mariscalco at Glenfield Hospital in Leicester.

Normally, younger patients such as me — under 65 — are given mechanical valves made from metal and silicone, but these can trigger blood clots because the body attacks them.

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So you need to stay on anticoagulants for life, which means you need regular monitoring and you have a higher risk of bleeding.

There are newer valves, shaped from animal tissue, that avoid this problem, but traditionally they’ve been offered only to older patients, since calcium builds up on them, so they stiffen and fail within ten to 15 years and need to be replaced.

Professor Mariscalco mentioned he was trialling a new valve, made from cow heart tissue, that had been specially treated so that calcium doesn’t build up on it as quickly. It could potentially last three times as long.

The surgery can be done minimally invasively, but because I also needed my aorta repaired, I had to have open-heart surgery — altogether this involved a four or five-hour procedure and a recovery period of up to a year, but it was my only option.

Before my surgery, I spent a day putting my affairs in order for my children Anneka, 33, and Dan, 37.

I had the operation two months later, in August 2017, under general anaesthetic.

WHAT ARE THE RISKS?

Open-heart surgery has a mortality rate of around 2 per cent, as well as a 1 to 2 per cent risk of a stroke or needing a pacemaker afterwards. There is also a 1 to 2 per cent risk of permanent kidney damage.

‘This new valve is an absolute game-changer because it lasts three times as long as conventional valves,’ says Toufan Bahrami, a consultant cardiac surgeon at Harefield Hospital in London.

‘So instead of offering animal tissue valves only to the over-70s, we can now offer them to much younger people and spare them a lifetime on anticoagulant drugs.’

I was in intensive care for 48 hours afterwards, but there was very little pain — I took codeine, and then paracetamol. Six days after the surgery, I went home, still very weak — I could only walk for five minutes at a time. But I had no palpitations.

Six weeks later I could drive and I went back to work part-time after seven weeks.

Three months later, I started rehabilitation with gentle exercises while they monitored my blood pressure to avoid undue strain on the heart as it healed.

When Anneka’s daughter, Luna, was born last October, I travelled down to London to help. I’m still taking it easy and need to take warfarin for the first year as I developed a blood clot during surgery. But I can now exercise for 30 minutes in the gym. I’m delighted to be out of danger.

THE SURGEON

Professor Giovanni Mariscalco is a consultant cardiac surgeon at University Hospitals of Leicester NHS Trust.

Heart valve disease is one of the most common types of heart disease — around 20,000 Britons have heart valve surgery annually — and in 30-40 per cent of cases it is a problem with the aortic valve, which controls blood flow from the heart to the rest of the body.

This valve can become calcified and stiffened as we age, so it does not open and close properly. Or it can become flabby and loose so that blood flows back into the heart. The aorta can also enlarge and start thinning, and will be in danger of rupturing.

The heart then has to work much harder, the heart wall thickens and patients start feeling chest pain. They can also become tired and breathless because not enough oxygenated blood is pumped around the body. Over time, this can lead to heart failure — or the heart can suddenly fail, which can be fatal.

We can try to repair one or more of the faulty flaps of the aortic valve, but often the valve is too badly damaged, so patients need replacement surgery.

A new type of animal tissue replacement valve overcomes two key problems with existing options — it avoids the need for blood-thinning medication as with mechanical valves, and it should last longer than other animal tissue valves.

Known as the Inspiris Resilia, it’s made from tissue from cow pericardium (the heart lining) and uses new anti-calcification technology which prevents the valve becoming stiff and damaged.

Open-heart surgery has a mortality rate of around 2 per cent, as well as a 1 to 2 per cent risk of a stroke or needing a pacemaker afterwards

Exactly how this works is a commercial secret, but the body seems to react to it far less strongly, and extensive testing suggests it lasts three times as long as existing valves — 20 or 30 years — although no long-term evidence is yet available.

This is very exciting because it means we can now offer this valve to younger patients. It was introduced to the UK last year and Annie was our first patient at Glenfield. It is available at only a few specialist NHS hospitals.

The new valve should also make minimally invasive valve replacement possible for older patients who are not fit enough for open heart surgery.

Most surgical aortic valves are rigid, made from metal and other artificial materials, and can be inserted only by opening up the chest. But the new valve is flexible and is designed to collapse so it can go through a peripheral artery and then expand once in place.

The operation takes around two hours, though in Annie’s case it took around five hours since we also needed to repair the damaged aorta using an artificial graft.

First, I make an incision — usually 4-5cm — over the sternum or breastbone and then cut through the bone to reach the heart.

We attach the patient to a heart-lung bypass machine which will take over the heart’s function while we operate. I then open the aorta and cut the diseased valve away, and select the right size of valve — it comes in six sizes, ranging from 19mm to 29mm.

I stitch the prosthetic valve into place then we start the heart again. Finally, we close the breast bone using metallic wires, which will stay in place for life, and stitch up the incision.

Most patients go home within a week: they cannot lift weights, move quickly or drive during the six weeks while the breast bone heals. The valve starts working as normal straight away, so symptoms should disappear.

If this new valve lives up to its promise, it could be used in the majority of valve replacements.